Congestive Heart Failure 30-Day Readmission: Descriptive Study of Demographics, Co-morbidities, Heart Failure Knowledge, and Self-Care

Abstract

BackgroundCongestive heart failure (CHF) readmissions are associated with substantial financial and medical implications. We performed a descriptive study to determine demographic, clinical, and behavioral factors associated with 30-day readmission. Materials and methodsPatients hospitalized with CHF at William Beaumont Hospital in Royal Oak, MI, from March 2019-May 2019 were studied. Response to heart failure knowledge and self-care questionnaires along with the patients' demographic and clinical factors were collected. Thirty-day readmission to any of the eight hospitals in the Beaumont Health System was documented. ResultsOne-hundred ninety-six (196) patients were included. The all-cause 30-day readmission rate was 23%. A numerical higher rate of readmissions was observed among males (23.7% vs 22.2%), current smokers (27.3% vs 22.9%), and patients with peripheral vascular disease (PVD; 28.9% vs 21.2%), diabetes mellitus (DM; 26.4% vs 18.9%), hypertension (HTN; 26.4% vs 10%), coronary artery disease (CAD; 24.6% vs 19%), and prior history of cerebrovascular accident (CVA; 28.9% vs 21.2%) (p>0.05). Reduced left ventricular ejection fraction (LVEF) was associated with higher readmissions (24.4% vs 20.5%, p=0.801). Patients with the highest reported questionnaire scores corresponding to better heart failure knowledge and self-care behaviors at home were readmitted at a similar rate compared to those scoring in the lowest interval (25%, p=0.681). ConclusionThough statistically insignificant due to the limitations of sample size, a higher percentage of readmissions was observed in male patients, current smokers, reduced LVEF, and higher comorbidity burden. Better reported patient self-care behavior, medication compliance, and heart failure knowledge did not correlate with reduced readmission rates. While the impact of medical comorbidities on 30-day readmissions is better established, the role of socioeconomic factors remains unclear and might suggest a focus for future work.

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“…This was comparable with regular hospitalisation, where studies have demonstrated a 30-day rehospitalisation rate of 18% to 23%. 13 , 14 Some differences in the conversion rate between the difficult hospitals were observed. Potential explanations could be the fact that more patients had ischemic heart disease, diabetes mellitus, and low renal function.…”

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“…Median (IQR) length of stay for all hospital readmissions was 4 days (2, 7) [planned -2 days (0, 5), unplanned -4 days]. 2,8 Mortality rate in 1 month, 3 months, 6 months, 1 year and 2 years of the index hospital admission were 2%, 6%, 9%, 16% and 23%, respectively.…”

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“…[2][3] Furthermore, HF patients live in an unrelenting cycle of deterioration, with variable stretches of stability punctuated by episodes of decompensation requiring emergency department visits often resulting in hospital admissions; each revolution of this cycle worsens patient morbidity and mortality. 4,5 The American Heart Association and the American College of Cardiology have staged HF from A to D, based on clinical symptomatology. 6 Stage A and B patients have no signs or symptoms of HF.…”

“…2-3 Furthermore, HF patients live in an unrelenting cycle of deterioration, with variable stretches of stability punctuated by episodes of decompensation requiring emergency department visits often resulting in hospital admissions; each revolution of this cycle worsens patient morbidity and mortality. 4,5…”